�������ڷ���������ת�����Ʋ���

??Treatment strategy of pancreatic neuroendocrine neoplasms with liver metastasis CHEN Luo-hai??CHEN Jie. Department of Gastroenterology??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080??China
Corresponding author: CHEN Jie??E-mail: chen0jie@hotmail.com
Abstract About 20% to 64% of patients with pancreatic neuroendocrine neoplasms (panNEN) had advanced disease with liver being the most common location of distant metastasis. Liver metastasis is not the contraindication of surgery. Curative resection should still be considered in patients with G1 or G2 disease. In respect of patients with unresectable disease, systematic therapy or nuclide therapy combined with intervention treatment should be applied while liver transplantation can be used only in a small number of selected patients. Temozolomide monotherapy or combined with capecitabine may be effective in patients with well differentiated G3 pancreatic neuroendocrine tumor. As for pancreatic neuroendocrine carcinoma, platinum-based chemotherapy is the first-line treatment option.     

���Ե�����Ⱦ������ָ�ϣ�2018��������

??A review of Tokyo Guidelines 2018 for the management of acute biliary infections HU Feng-lin??SHANG Dong??ZHANG Hao-xiang??et al. Department of Abdominal Emergency Surgery??the First Affiliated Hospital of Dalian Medical University; Treatment Center of Traditional Chinese Medicine and Western Medicine for Pancreaticobiliary Diseases??Dalian 116000??China
Corresponding author??SHANG Dong??E-mail??tougao1971@163.com
Abstract The Tokyo Guidelines??published in 2007??is the first worldwide guideline to addressing acute cholangitis and acute cholecystitis and was revised in 2013. In line with the results of the epidemiological study of acute biliary tract infection in Japan-China Taiwan multicenter large sale from 2011 to 2013??the guideline was updated again in 2017 and published Tokyo Guidelines 2018. Tokyo Guidelines 2018 is divided into 10 parts. It covers the background of the guidelines??diagnosis of acute cholangitis and acute cholecystitis??grading of severity??use of antibiotics??choice of biliary drainage technique??laparoscopic cholecystectomy safety steps??treatment processes and so on. At the same time??for the convenience of clinical management??it developed a management bundle supporting with video and mobile software client. The Tokyo Guideline 2018 summarizes the guiding principles of clinical diagnosis and treatment of acute cholangitis more comprehensively??and reflects the current status and progress in the treatment of acute cholangitis and cholecystitis.     

���긹�ɹ��޸�ǻ�����Ʋ���

??Laparoscopic inguinal hernia repair in elderly patients LI Jian-wen, YUE Fei. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
Corresponding author??LI Jian-wen??E-mail??ljw5@yeah.net
Abstract The elective inguinal hernia repair is recommended for elderly patients. The preperitoneal repair is a rational operation due to the weakness of transversalis fascia. Laparoscopic preperitoneal repair, including transabdominal preperitoneal prosthetic (TAPP) and totally extraperitoneal prosthetic (TEP), are safe procedures for elderly patients with ASA score 1-2. The therapeutic effects of laparoscopic inguinal hernia repair are similar between elderly and general population. The rates of postoperative urinary retention and seroma might increase slightly, but laparoscopic procedure has the tendency to achieve better results in chronic pain, comfort and satisfaction. The pathophysiological effects of pre-pneumoperitoneum should be taken into consideration, when TEP is selected for octogenerians.     

���긹�ɹ����ռ�����ע������

??Announcements in elderly inguinal hernia ambulatory surgery SUN Li, CHEN Jie, SHEN Ying-mo. Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
Corresponding author: CHEN Jie , E-mail??chenjiejoe@sina.com
Abstract Among the inguinal hernia patients in China, the proportion of elderly patients is relatively large. How to make the ambulatory surgery of elderly inguinal hernia patients be safe and convenient is a problem that surgeons have to face. Firstly, case screening is very important. For elderly patients with severe internal diseases, evaluation and screening must be performed before surgery to establish safety standards. Patients who do not accord with the safety standards for ambulatory surgery should not be scheduled for ambulatory surgery; Secondly, selection of the anesthesia and surgical methods should have as less as possible impact for the patients, so as to facilitate rapid recovery after surgery. Lastly, postoperative management is also very important. Surgeons should pay attention to observing the change of the postoperative condition. Complete follow-up after discharge and smooth communication and feedback channels can help surgeons to know and handle in a timely manner in the emergency event.     

һ�뷨�ȳ��Ǻ����ڸ�ǻ����ʮ��ָ���г����������о�

??Single-stitch pancreatic duct suture for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy??A multiple center prospective study HONG De-fei*??LIU Jian-hua??LIU Ya-hui??et al. *Department of General Surgery??Sir Run Run Shaw Hospital??Zhejiang University??Hangzhou 310016??China
Corresponding author??HONG De-fei??E-mail??hongdefei@zju.edu.cn
HONG De-fei, LIU Ya-hui, LIU Jian-hua and LIU Jun are the first authors who contributed equally to the article
Abstract Objective To investigate the role of Single-stitch pancreatic duct suture for pancreaticojejunostomy technique (SSPJ) in laparoscopic pancreaticoduodenectomy ??LPD??. Methods Between April 2016 and March 2018??the clinical data of patients underwent LPD in Sir Run Run Shaw Hospital of Zhejiang University??Frist clinical hospital of Jilin university??Second Affiliated Hospital of Hebei Medical University??Shandong Provincial Hospital??and Zhejiang provincial people’s hospital were collected prospectively. All patients underwent LPD using SSPJ technique. Results All patients underwent laparoscopic procedure. 9 patients (2.2%) conversed to open operation. The mean time for SSPJ was??32.2±7.6??min. The mean operation time was (353.9±104.8) min. The mean estimated blood loss was ??327.2±362.3??mL. Postoperative complications included??42 patients??10.2%?? had Biochemical leak??25 patients??6.1%?? had pancreatic fistula grade B??4 patients??1.0%?? had pancreatic fistula grade C??25 cases??6.1%?? had bile leakage??23 patients ??5.6%??had postoperatively bleeding??22 cases ??5.3%??haddelayed gastric empty??9 cases??2.3%?? had intra-abdominal infection and 11 cases??2.7%?? had pulmonary infection postoperatively. 18 patients need re-operation??7 patients??1.1%??died within 30 days postoperative. The mean postoperative hospital stay is ??18.6±10.6??d. Pathologic results showed pancreatic ductal adenocarcinomas in 121 cases??29.37%????distal bile duct carcinomas in 95 cases(20.06%)??Carcinoma of duodenal papilla in 47cases??11.4%????ampullary tumors in 42 cases??10.2%????duodenal carcinoma in 21 cases??5.1%????solid pseudopapillary tumor of pancreas in 16 cases??3.9%????intra-ductal papillary mucinous neoplasms in 15 cases??3.6%????neuroendocrine tumors in 16??3.9%?? patient and 31 cases with other diagnosis. Conclusion Our results show that SSPJ is a simple??safe and feasible laparoscopic pancreaticojejunostomy technique??which worth to be popularized.     

��״���������¼����ĺ���Ӧ�ü�չ��

??Reasonable application and prospect of new technology in treatment of thyroid disease TIAN Wen*?? FEI Yang??XI Hong-qing. *Department of General Surgery??Chinese People’s Liberation Army General Hospital??Beijing 100853??China
Corresponding author??TIAN Wen??E-mail??tianwen301_cta01@163.com
Abstract With the progress of medicine??more and more new technologies are applied to the diagnosis and treatment of diseases. Thyroid surgery technology has also developed leaps and bounds. Surgeons have more perfect requirements for surgical treatment.The application of nerve monitoring technology has made thyroid surgery more refined and significantly improved the safety and efficiency of operation. The nano-carbon parathyroid gland negative imaging technology could identify parathyroid gland more precise??and it also has the lymph node tracer effect??which can guide the surgeon to clean up more lymph nodes and improve the operation effect.Endoscopic and robotic thyroid surgery can achieve the same curative effect as the traditional open operation. Furthermore??it also achieve the neck scarless cosmetic effect. It provides a new choice for patients with cosmetic needs. The continuous improvement and application of energy surgical instruments make the operation more efficient The application of autologous transplantation of parathyroid glands can better achieve the purpose of protecting the function of parathyroid glands. Surgeons should follow the principle of “rational selection and standard application” for the use of new technology??grasp the working principle and application skills of new technology in clinical work??clear its advantages and disadvantages??to ensure that the application of new technology is more safe and reasonable??and can bring benefit to the patient finally.